Acute Unilateral Toxoplasmic Iridocyclitis in an AIDS Patient

Rehder, José Ricardo Carvalho Lima; Burnier, M.; Pavésio, Carlos; Kim, Myung K.; Rigueiro, Moacyr Pezati; Petrilli, Ana Maria Noriega; Belfort, Rubens

doi:10.1016/0002-9394(88)90712-x

Cited by 51 publications

(14 citation statements)

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“…An American study reported that Toxoplasma gondii was involved in the pathogenesis of FHUS. [22][23][24][25][26] In our study, none of the six FHUS patients had typical chorioretinal lesions, but the number of FHUS cases is small. In Europe, Rubella virus infection was frequently linked to FHUS, whereas in Asia CMV has been reported as a frequent causal agent of FHUS.…”

Section: Discussioncontrasting

confidence: 58%

Viral causes of unexplained anterior uveitis in Thailand

Kongyai

Sirirungsi

Pathanapitoon

et al. 2012

Eye

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Aims To assess the possible role of virus infection in patients with unexplained anterior uveitis (AU). Methods Intraocular fluid and plasma samples of 30 HIV-negative AU patients who were unresponsive or poorly responsive to topical steroid therapy were analyzed for nucleic acid of cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV) by realtime polymerase chain reaction (PCR) and for intraocular antibodies against these viruses by Goldmann-Witmer coefficient (GWC) analysis. Of these 30 cases, 21 were tested for rubella virus by GWC analysis, 16 of which also had PCR assessment of aqueous for rubella virus. Results Viral uveitis determined by either real-time PCR and/or GWC was documented in 20 out of 30 patients (67%). Of 30 paired samples tested by both methods for HSV, CMV, and VZV, 15 showed positive results (CMV (10), HSV (4), and VZV (1)). Real-time PCR was positive in 8/15 (53%), whereas GWC was positive in 10/15 (67%). Out of 10 CMV-positive patients, four had endotheliitis, two had Posner-Schlossman syndrome, and one Fuchs heterochromic uveitis syndrome (FHUS). Five out of 21 (24%) samples tested by GWC for Rubella virus were positive, three of which exhibited clinical features of FHUS. Conclusions Our results indicate that CMV is a major cause of AU in Thailand and show that FHUS can be caused by both CMV and Rubella virus.

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Section: Discussioncontrasting

confidence: 58%

Viral causes of unexplained anterior uveitis in Thailand

Kongyai

Sirirungsi

Pathanapitoon

et al. 2012

Eye

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“…The iridocyclitis that accompanies retinal infections in these patients is believed to be a secondary, immunological reaction, and destruction of choroid is probably related to inflammation stimulated by the adjacent retinal infection. In contrast, organisms were found in an iris biopsy specimen from a patient with AIDS [21]. Other, similar cases have been suspected [19].…”

Section: Toxoplasmosis and Aidsmentioning

confidence: 96%

Ocular toxoplasmosis in the immunocompromised host

Holland¹

1989

Int Ophthalmol

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Disseminated toxoplasmosis is a well-known complication of immunodeficiency states, including those induced by malignancies, steroid and cytotoxic drug therapy, and AIDS. In immunodeficient patients, toxoplasmic infections of the eye are less common than toxoplasmic infections of other organs for unknown reasons. When ocular toxoplasmosis does occur in the immunodeficient host, or if immunosuppressive therapy is administered to patients with active disease, widespread tissue destruction by proliferating organisms may result. Immunodeficiency alone may not be sufficient, however, to cause reactivation of encysted organisms in retinochoroidal scars. Ocular toxoplasmosis in the immunocompromised host presents difficult problems in diagnosis and management. There may be a variety of clinical lesions, including single foci of retinochoroiditis in one or both eyes, multifocal lesions, or diffuse areas of retinal necrosis. The majority of lesions do not arise from the borders of preexisting scars, which suggests that they result from acquired infection or dissemination of organisms from nonocular sites of disease. Toxoplasma gondii may infect iris, choroid, and vitreous-tissues that are not usually infected in the immunocompetent host. Ocular lesions appear to respond to standard antiparasitic drug therapies, but continued treatment is probably necessary to prevent reactivation of disease in the most immunocompromised patients. The best treatment regimens have yet to be determined. Histopathologic studies show little retinal inflammation; therefore anti-inflammatory drugs, such as oral steroids, probably have no role in the management of infection.

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“…A large number of parasites are seen within the retina, the retinal pigment epithelium, choroid and optic nerve [332,345]. Rehder et al [346] reported the presence of T. gondii cysts in the iris of an AIDS patient who presented with unilateral iritis without chorioretinal disease. The widespread presence of the parasites along the different parts of the eye emphasizes the destructive role of the parasites in patients with AIDS.…”

Section: Histopathologymentioning

confidence: 99%

Immunopathogenesis of toxoplasmosis

Hegab

Al-Mutawa²

2003

Clinical and Experimental Medicine

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Toxoplasmosis is a ubiquitous infection affecting 500 million persons around the world, with a range of incidence 12%-90%, increasing with age, education, crowding and sanitary habits. Cats are the definitive host. Infection is primarily congenital but acquired ocular infection has been documented. The review focuses on the immunopathogenesis of toxoplasmosis with emphasis on the eye problem due to its morbidity. The response to infection correlates with both parasitic and retinal antigens. The clinical picture and histopathology is a reflection of the immune response which constitutes early humeral response which presents both systemically and locally primary infection and is elevated with reactivation. This is followed by the cellular response, varying from low grade monocular infilterate a total tissue destruction with response of live parasites especially in immuno-compromised patients. Penetration of the parasite and its enclosure within the parasitophorous vacuole and its eneyst all make its eradicatier impossible. This reflects the variability of antiparasitic therapy that include folate antagonists, macrolides, hydroxy naphthoquindones and fluoroquinolones. Use of corticosteroid should be limited to severe reactions and should be associated with specific therapy.

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Acute Unilateral Toxoplasmic Iridocyclitis in an AIDS Patient

Cited by 51 publications

References 0 publications

Viral causes of unexplained anterior uveitis in Thailand

Viral causes of unexplained anterior uveitis in Thailand

Ocular toxoplasmosis in the immunocompromised host

Immunopathogenesis of toxoplasmosis

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